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Update (10/25): Status of patients from the JCO Criticality
RADSAFERS,
I know that "the cat is already out of the bag," and it is like "closing the
barn door after the horses are gone," but after a reminder from a good friend, I
decided that we need to respect the victim's privacy and will henceforth refer
to the victims as Mr. A, B, and C, just as Japan's Science and Technology Agency
is doing. We knew their names because the media and initial Science and
Technology Agency's postings identified them. But I've noticed that all their
recent postings seem to be going out of their way to protect privacy (workers'
and residents') after the initial flurry of information. I have also reordered
the patients' status from highest dose to least.
Tosh Ushino, ICN Dosimetry, tushino@icnpharm.com
************************
RBC = Red Blood Cell WBC = White Blood Cell BP = Blood Pressure
Temp = Temperature Pulse = Pulse Rate Resp = Respiration rate
CRP = C-reactive protein
Mr. A: 17 Sv
--------------------------------------------------------------------------
10/09/99
Due to the effect of sedative, patient is not entirely coherent. Oxygen intake
through lung decreasing.
BP: 136/60 mm Hg Pulse: 104/min.
Resp: 12/min. Temp: 37.5 C
WBC and platelet count continuing to decrease. No indication of infection.
Received good advise from Dr. Gale.
Treatment Direction: Ventilate, take precaution against infection.
Others: Vigilance must be maintained.
10/12/99 19:30
Providing sedative.
BP: 147/72 mm Hg Pulse: 108/min.
Resp: 16/min. Temp: 36.9 C
Continuing with ventilation. Since the previous day, providing hormone to assist
in tissue regeneration to repair lung impediment, chest X-rays reveal slight
improvement and there is improved oxygen intake through lungs. Continued
transfusion of RBCs and platelets is required. There is concern for
complications due to infection, but thus far there is no sign of infection. No
bowel movement or blood in stool.
Treatment Direction: Continue with ventilation, prevent infection, nutritional
management, and transfusion.
Others: Fever and inflammation maybe masked by tissue regeneration hormone.
Vigilance must be maintained.
10/13/99 17:00
Providing sedative.
BP: 139/72 mm Hg Pulse: 103/min.
Resp: 19/min. Temp: 36.7 C
Continuing with ventilator. Decrease in renal function, possibly result of
medication. Some bleeding from lining of mouth and stomach. Continued
transfusion of RBCs and platelets is required. There is concern for
complications due to infection, but thus far there is no sign of infection. No
bowel movement or blood in stool.
Treatment Direction: Continue with ventilation, prevent infection, nutritional
management, and transfusion.
Others: Fever and inflammation maybe masked by tissue regeneration hormone.
Vigilance must be maintained.
10/14/99 17:00
No major change since the previous day. Providing sedative.
BP: 138/70 mm Hg Pulse: 106/min.
Resp: 19/min. Temp: 37.3 C
Continuing with ventilation management. Diminished renal function. Some bleeding
from lining of mouth. Continued transfusion of RBCs and platelets is required.
There is concern for complications due to infection, but thus far there is no
sign of infection. No bowel movement or blood in stool.
Treatment Direction: Continue with ventilation, prevent infection, nutritional
management, and transfusion.
Others: Vigilance must be maintained.
10/15/99 17:00
No major change since the previous day. Providing sedative.
BP: 158/76 mm Hg Pulse: 114/min.
Resp: 13/min. Temp: 38.1 C
Continuing with ventilation. Oxygen intake is good. Renal function stable. Some
bleeding from lining of mouth. Requiring transfusion of RBCs and platelets.
Concern for complication from infection but thus far no indication of infection.
Epilation observed. There was a bowel movement.
Treatment Direction: Evaluating feasibility of ?direct feeding method to
intestine?(?). Ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/16/99 17:00
Providing sedative.
BP: 133/64 mm Hg Pulse: 114/min.
Resp: 24/min. Temp: 38.2 C
Continuing with ventilation. Renal function showing some improvement. Requiring
transfusion of RBCs and platelets. WBC count has increased. Performing
evaluation to determine if borrow marrow transplant was successful. Appearance
of radiation burn changed. The color is dark red, and blisters appearing in
upper right thigh. It is unclear if there is infection. No bowel movement.
Treatment Direction: Will evaluate the trend of WBC to determine if bone marrow
was successful. Still evaluating feasibility of ?direct feeding method to
intestine.? Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/17/99 17:00
BP: 130/58 mm Hg Pulse: 120/min.
Resp: 12/min. Temp: 37.8 C
Providing sedative and continuing with ventilation. X-ray reveals increase in
lung damage, but oxygen intake is satisfactory. Renal function stable. Rate of
RBC and platelet decrease has eased. WBC count had increased rapidly, confirming
the success of bone barrow transplant. It is still unclear if there is
infection. There was diarrhea but no blood in stool.
Treatment Direction: Will evaluate the trend of WBC to determine if bone marrow
was successful. Still evaluating feasibility of ?direct feeding method to
intestine.? Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
WBC Count Trend
============================
10/06 600/mm^3 1st transplant
10/07 100 2nd transplant
10/11 0
10/15 16:00 300
10/16 00:00 600
06:00 1000
16:00 2000
10/17 06:00 4800
10/18/99 17:00
No major change since the previous day.
BP: 128/60 mm Hg Pulse: 124/min.
Resp: 18/min. Temp: 38.0 C
Providing sedative and continuing with ventilation. X-ray reveals no major
change in lung, and renal function stable. Area with erythema has more blisters,
but no clear indication of infection. Still requiring RBC and platelet
transfusion. WBC count in small blood vessels increased to 8,300/mm^3.
Chromosome study confirmed that the increase in WBC count is due to transplanted
bone marrow. Temperature is 38.0 C but there is no indication of infection. No
bowel movement.
Treatment Direction: Prevention of transplant rejection, early indication and
treatment. Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/19/99 17:00
No major change since the previous day.
BP: 114/50 mm Hg Pulse: 114/min.
Resp: 20/min. Temp: 38.1 C
Continuing with ventilation. Renal function stable. Blistering in the upper
right thigh area with erythema has increased but no clear indication of
infection. Still requiring RBC and platelet transfusion. WBC count in small
blood vessels increased to 8,200/mm^3. Fever with temperature of 38.0 C but
there is no indication of infection. No bowel movement.
Treatment Direction: Early detection and treatment to prevent of transplant
rejection, . Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/20/99 17:00
No major change since the previous day.
BP: 150/74 mm Hg Pulse: 116/min.
Resp: 20/min. Temp: 38.0 C
Continuing with ventilation. No indication of transplant rejection. No major
change in lung function or in X-ray. Renal function stable. More blistering in
the upper right thigh area with erythema but no clear indication of infection.
Still requiring RBC and platelet transfusion. WBC count in small blood vessels
increased to 7,200/mm^3. Fever with temperature of 38.0 C but there is no
indication of infection. Two diarrhea (bowel movements) but no blood in stool.
Treatment Direction: Early detection and treatment to prevent of transplant
rejection, . Continue ventilation management, infection prevention, nutrition
management, continued transfusion management, and detailed total body
management.
Others: Vigilance must be maintained.
10/21/99 17:00
No major change since the previous day.
BP: 116/52 mm Hg Pulse: 118/min.
Resp: 18/min. Temp: 38.3 C
Continuing with ventilation. No indication of transplant rejection. No major
change in lung function or in X-ray. Renal function improving. More blistering
on the right arm and is unlike normal thermal burn but no clear indication of
infection. Still requiring RBC and platelet transfusion. WBC count in small
blood vessels increased to 7,700/mm^3. Fever with temperature of 38.0 C but
there is no indication of infection. No bowel movement.
Treatment Direction: Recommend evaluation of intestinal function. Early
detection and treatment to prevention of transplant rejection, . Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Vigilance must be maintained.
10/22/99 17:00
No major change since the previous day.
BP: 122/72 mm Hg Pulse: 124/min.
Resp: 21/min. Temp: 38.4 C
Continuing with ventilation. No major change in lung function or in X-ray.
Continuing indication of moderate renal function damage. Blistering progressed
to both thighs and behind neck. Started additional treatment expected for normal
thermal burns.Still requiring RBC and platelet transfusion. WBC count in small
blood vessels is 8,500/mm^3. Small bowel movement.
Treatment Direction: Evaluation of intestinal function. Early detection and
treatment to prevention of transplant rejection, . Continue ventilation
management, infection prevention, nutrition management, continued transfusion
management, and detailed total body management.
Others: Vigilance must be maintained.
10/23/99 17:00
No major change since the previous day, but areas of skin and lining radiation
damage increasing.
BP: 120/62 mm Hg Pulse: 120/min.
Resp: 20/min. Temp: 38.5 C
Continuing with ventilation. No major change in lung function or in X-ray. No
change to renal function damage. Blistering on anterior upper torso surface
including face and peeling of skin progressed, clearly changing the appearance
of the radiation thermal burn. Radiation damage to lining of mouth also
appeared, yet there still is no clear indication of infection. Still requiring
RBC and platelet transfusion. WBC count in small blood vessels is 10,700/mm^3.
Fever with temperature of 38 C but still no indication of fever. Three bowel
movements with green stool.
Treatment Direction: Prevention of infection as result of sking peeling. Early
detection and treatment to prevention of transplant rejection, . Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Vigilance must be maintained.
10/24/99 17:00
No major change since the previous day.
BP: 126/58 mm Hg Pulse: 126/min.
Resp: 12/min. Temp: 37.8 C
Continuing with ventilation. No major change in lung or to renal function.
Blistering on anterior upper torso surface including face and peeling of skin
continuing. In partcular, the changes observed on the right thigh area thought
have received the highest radiation dose is distinctive of radiation damage, and
further development requires careful observation. Still requiring RBC and
platelet transfusion. WBC count in small blood vessels is 12,700/mm^3. No
indication of transplant rejection. Two bowel movements with green stool.
Treatment Direction: Prevention of infection as result of sking peeling. Early
detection and treatment to prevention of transplant rejection, . Continue
ventilation management, infection prevention, nutrition management, continued
transfusion management, and detailed total body management.
Others: Vigilance must be maintained.
Mr. B: 10 Sv
---------------------------------------------------------------------------
10/09/99
BP: 109/59 Pulse: 78/min. Temp: 36.8 C
Blood oxygen level: 99% WBC count: 0/mm^3
Hemoglobin conc.: 9.5 g/dl Platelet count: 43,000/mm^3
10/12/99 19:30
Pain in lining of the mouth has increased substantially, but overall condition
is as good as before. No indication of infection. Clear, conscious.
BP: 122/67 Pulse: 67/min. (normal) Temp: 36.5 C
Blood oxygen level: 99% WBC count: 30/mm^3
Hemoglobin conc.: 9.5 g/dl Platelet count: 29,000/mm^3
10/13/99
Increased pain in lining of the mouth. Overall condition is as good as before.
No indication of infection. Clear, conscious.
BP: 118/63 Pulse: 74/min. (normal) Temp: 36.7 C
Blood oxygen level: 99% WBC count: 20/mm^3
Hemoglobin conc.: 8.8 g/dl Platelet count: 10,000/mm^3
10/14/99
Reddening of lining of mouth thought to be from radiation damage. Severe pain in
the mouth. Ulceration (edema?) on inside lining of cheeks. No major change to
overall condition. No clear indication of infection. Platelet count increased
due to transfusion.
BP: 119/66 Pulse: 70/min. (normal) Temp: 36.8 C
Blood oxygen level: 98% WBC count: 20/mm^3
Hemoglobin conc.: 8.9 g/dl Platelet count: 70,000/mm^3
10/15/99
Sore inside mouth has worsened and appearance of fever and inflammation. No
other major change to overall condition.
BP: 114/65 Pulse: 75/min. (normal) Temp: 37.5 C
Blood oxygen level: 99% WBC count: 10/mm^3
Hemoglobin conc.: 9.1 g/dl Platelet count: 19,000/mm^3
CRP: 5.04 mg/dl
10/16/99
Painful sore inside mouth, fever and inflammation continues. Vomited once. No
other major change to overall condition.
BP: 109/60 Pulse: 73/min. Temp: 37.8 C
Blood oxygen level: 98% WBC count: 0/mm^3
Hemoglobin conc.: 8.7 g/dl Platelet count: 51,000/mm^3
CRP: 5.68 mg/dl
10/17/99
Patient under considerable pain due to radiation induced sore inside mouth. Due
to worsening fever and inflammation, infection is strongly suspected.
Antibiotics and intravenous feeding provided. No indication of deterioration of
lung function.
BP: 116/63 Pulse: 79/min. Temp (peak): 38.5 C
Blood oxygen level: 99% WBC count: 0/mm^3
Hemoglobin conc.: 7.9 g/dl Platelet count: 44,000/mm^3
CRP: 6.74 mg/dl
10/18/99
Slight improvement in sores in mouth. Providing medication for strong throat
pain. No indication of deterioration of lung function.
BP: 105/59 Pulse: 76/min. Temp (peak): 37.5 C
Blood oxygen level: 98% WBC count: 10/mm^3
Hemoglobin conc.: 8.1 g/dl Platelet count: 24,000/mm^3
CRP: 9.87 mg/dl
10/19/99
Radiation cause pain in lining of mouth showing sign of improvement.
BP: 122/61 Pulse: 78/min. Temp (peak): 38.3 C
Blood oxygen level: 98% WBC count: 30/mm^3
Hemoglobin conc.: 8.4 g/dl Platelet count: 13,000/mm^3
CRP: 10.17 mg/dl
10/20/99
Providing medication for strong throat pain and pain on finger tips. Fever and
inflammation continues. No indication of deterioration of lung function.
BP: 112/72 Pulse: 87/min. Temp (peak): 38.1 C
Blood oxygen level: 98% WBC count: 60/mm^3
Hemoglobin conc.: 8.0 g/dl Platelet count: 41,000/mm^3
CRP: 11.52 mg/dl
10/21/99
Chromosome analysis of bone marrow collected on 10/18 shows presence of cells
from the patient as well cells from the donor co-existing. Continuing strong
throat pain, pain on finger tips and soles of feet. Change in skin tone and
swelling of fingers, and face observed. Fever and inflammation continues. No
indication of deterioration of lung function. Overall conscious and clear, but
showing signs of exhaustion.
BP: 110/66 Pulse: 87/min. Temp (peak): 38.2 C
Blood oxygen level: 98% WBC count: 100/mm^3
Hemoglobin conc.: 8.5 g/dl Platelet count: 26,000/mm^3
CRP: 13.84 mg/dl
10/22/99
Continuing strong throat pain, pain on finger tips and soles of feet. No change
in skin tone and swelling of fingers, and face. Fever and inflammation
continues. No indication of deterioration of lung function. Increase WBC count
indicating recovery of bone marrow.
Clear, conscious.
BP: 120/68 Pulse: 88/min. Temp (peak): 38.2 C
Blood oxygen level: 98% WBC count: 230/mm^3
Hemoglobin conc.: 8.4 g/dl Platelet count: 8,000/mm^3
CRP: 14.50 mg/dl
10/23/99
Continuing strong throat pain, pain on finger tips and soles of feet. No change
in skin tone and swelling of fingers, and face. Fever and inflammation
continues. No indication of deterioration of lung function. WBC count continuing
to increase. Increase in RBC count indicates bone marrow recovery but tests need
to be conducted early next week to determine if recovery is due to transplanted
umbilical cord blood cell or recovery of his own stem cells.
Clear, conscious.
BP: 124/80 Pulse: 88/min. Temp (peak): 38.1 C
Blood oxygen level: 99% WBC count: 500/mm^3
Hemoglobin conc.: 8.0 g/dl Platelet count: 34,000/mm^3
CRP: 8.78 mg/dl
10/24/99
Some improvemenmt in throat pain, but numbness in finger tips and soles of feet
increasing. Increase in change to skin and swelling of face. Fever continues. No
indication of deterioration of lung function. WBC count continuing to increase.
Clear, conscious.
BP: 140/80 Pulse: 92/min. Temp (peak): 38.8 C
Blood oxygen level: 99% WBC count: 800/mm^3
Hemoglobin conc.: 8.6 g/dl Platelet count: 19,000/mm^3
CRP: 7.45 mg/dl
Mr. C: 3 Sv
------------------------------------------------------------------------
10/09/99
Stable.
Temp: 35.9 C BP: 110/70
WBC and lymphocyte count remain stable.
10/10/99
Stable.
Temp: 35.5 C BP: 115/70
WBC and lymphocyte count remain stable.
10/11/99
Stable.
Temp: 36.0 C BP: 120/80
WBC and lymphocyte count remain stable.
10/12/99
stable.
Temp: 36.1 C BP: 115/90
WBC and lymphocyte count remain stable.
10/14/99
Stable, conscious, clear.
Temp: 36.0 C BP: 110/80
WBC and lymphocyte count decreasing.
10/15/99
Stable.
Temp: 35.6 C BP: 115/75
WBC and platelet count decreasing.
Borrow marrow will be examined to assess recovery.
10/16/99
Stable.
Temp: 35.8 C BP: 130/90
WBC: 4100/mm^3 Platelet count: 42,000/mm^3
WBC and platelet count trending down.
10/17/99
Stable.
Temp: 36.0 C BP: 130/75
WBC: 3000/mm^3 Platelet count: 33,000/mm^3
WBC and platelet count trending down. Platelet transfusion.
10/18/99
Stable.
Temp: 36.2 C BP: 120/82
WBC: 2400/mm^3 Platelet count: 58,000/mm^3
WBC count trending down. Platelet count increased due to transfusion.
10/19/99
Stable.
Temp: 36.0 C BP: 115/80
WBC count trending down. In order to prevent infection, it is planned to move
the patient to a sterile isolation room today.
10/20/99
Stable.
Temp: 35.8 C BP: 140/75
WBC and platelet count trending down. In order to prevent infection, the patient
was moved to a sterile isolation room yesterday.
10/21/99
Stable.
Temp: 36.0 C BP: 125/83
Performed second platelet transfusion on the previous day.
10/22/99
Stable.
Temp: 35.8 C BP: 125/80
WBC count generally stable.
--------------------------------------------------------------------------
Toshihide "Tosh" Ushino, CHP Tel: (800) 548-5100 x2413
Product Development Manager Fax: (714) 668-3149
Dosimetry Div., ICN Biomedicals, Inc. Email: tushino@icnpharm.com
3300 Hyland Ave., Costa Mesa, CA USA 92626 tushino@hotmail.com
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